Corner High School 4301 Warrior Jasper Road Dora, Alabama 35062 Phone: 205-379-3200 Fax: 205-379-3215 TRANSCRIPT RELEASE FORM For former students

I give permission to Corner High School to release an official transcript for the following: Student Name ______________________________________________________________________________________ (please provide name under which student was enrolled) Birth Date _______________________________ Date Last Attended (for former students) ________________________ Please send my transcript to __________________________________________________________________________ Address: ______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ I have enclosed the $3.00 transcript fee in the form of; (please check one) Money order Cash Check to CHS (checks must contain name, address, Driver’s License number, and 2 phone numbers)

________________________________________________________________________________________________ Signature of Student (if 18 years of age or older) Date ________________________________________________________________________________________________ Signature of Parent/Guardian (if student is a minor) Date How may we reach you by phone? ___________________________________________________________________ How may we reach you by email? ____________________________________________________________________